Driven to Distraction (Revised) Read online

  This period of relative calm and accommodation ended as Max encountered the greater stimulations the world of high school offered. He felt an internal restlessness that could only be soothed by engaging in some external situation of equally high energy.

  He began to find release in athletics, becoming a fanatical long-distance runner and wrestler. He talked about “the pleasure in the pain of the long-distance run” and the mental relief, the feeling of “absolute psychic clarity” in the last half mile. He was also an excellent wrestler. He was especially good at the move at the start of a period when you explode out of your opponent’s grasp. Here at last was a place where he could legitimately go crazy, where at last he could release all the energy he had stored in his cells and slash through the bonds of good behavior as if escaping from a briar patch. In wrestling Max could break free. He also loved the agony of getting down to the proper weight for a meet. “I hate it, of course,” he would say, “but I also love it. It focuses my mind on one thing, one goal.”

  But, as relatively adaptive as his sports were, he also began to flirt with danger. He began experimenting with drugs, particularly cocaine, which he noticed calmed him and helped him focus. He was always on the go. He had more girlfriends than he could keep straight. All this left him little time for studying. He continued to play a game he called “chicken,” walking into exams totally unprepared and seeing if he could fake his way through. He began to discover that he couldn’t do this as well as he had in grade school.

  In a part of his being, he knew he was courting disaster. On his way out the door one day, he casually said to his mother, “You know, Mom, I’m a walking time bomb.”

  Thinking he was joking, she answered with a laugh, “At least you’re not a dud.” The family had learned long ago to turn Max’s self-deprecatory remarks into jokes. They weren’t unfeeling; they just didn’t know what else to do.

  What happened next could have happened in many different ways. Or, it might not have happened at all. There are many adult Maxes out there who have managed not to trip and fall. They simply live frenetic lives, a whirligig of high stimulation and often high achievement, with an abiding sense that their world is on the brink of collapse.

  But Max, fortunately, did trip and fall. It could have been academic failure or drugs or alcohol or some high-risk prank. In Max’s case, though, it was the unusual route of wrestling. In an effort to make weight, he violated all the rules; he was found comatose and thoroughly dehydrated in his basement room. When he was hospitalized, his family doctor was sensitive enough to see this episode as a signal of some pretty serious psychological problems.

  In the course of Max’s evaluation, neuropsychological testing revealed, in addition to Max’s already documented high IQ, a number of other issues. There was good evidence that he had attention deficit disorder. Second, projective testing revealed extremely low self-esteem as well as recurring depressive themes and images. In marked contrast to his cheerful exterior, Max’s inner life was, in the words of the psychologist, “full of chaos and impulse surrounded by a fog of depression, heated by desperation.”

  At a parent-child meeting with the psychologist, Max’s mother broke down in tears. “It’s not your fault,” Max said softly. His father cleared his throat defensively. “It’s not your fault either, Dad.”

  “It’s nobody’s fault,” the psychologist interrupted, and began to explain to Max and his parents what they had been living with for these many years.

  “But if it’s this attention deficit thing,” his mother said, “why didn’t we pick it up earlier? I feel so guilty.”

  “It often goes undiagnosed,” the psychologist said, “particularly in bright children.”

  The more Max listened, the more things began to fit together and make sense to him. What he had known about himself, dimly, intuitively, for a long while finally had a name. “Just giving it a name really helps,” Max said.

  “Better than calling you Mad Max,” his father said. “I guess we all have some guilt to deal with.”

  “But the good news is that there are some corrective steps we can take now,” the psychologist said. “It won’t be an easy process, but life will be a lot better than it has been.”

  There are a few points from Max’s story worth highlighting. He came from a relatively stable family. It is important to dispel any notion that ADD is someone’s fault. While inadequate parenting can exacerbate the situation, it does not cause it. We don’t know for sure what causes it—as stated earlier, our best evidence says it’s genetic—but we do know it is not the result of bad mothering or fathering.

  Max’s high IQ delayed the diagnosis of ADD. When a child is obviously bright and gets good grades, one often fails to consider ADD as a possibility. This is a mistake. Many very bright children have ADD. Missing the diagnosis in these bright children can lead them to use their intelligence and creativity in the service of getting into interesting mischief but to miss out on making the most of school.

  A corollary to this point is that the diagnosis of ADD should not carry with it the perception of an educational death sentence. After all the testing and psychiatric interviews children and their parents go through en route to the diagnosis, many a parent and child leaves the consulting room where the diagnosis of ADD has just been pronounced thinking they have been told, in very fancy language, that the child is stupid. A frequent though hidden component of the emotional experience of ADD is the feeling of being defective or retarded. It is very important that parents and teachers reassure the child about this matter. While one doesn’t rejoice at the diagnosis of ADD, neither need one despair. With help, children with ADD can draw on their emotional and intellectual strengths.

  Max’s story also brings out the crucial difference between the primary and secondary symptoms of ADD. Primary symptoms are the symptoms of the syndrome itself: distractibility, impulsivity, restlessness, and so forth. The secondary symptoms, and the ones that are most difficult to treat, are the symptoms that develop in the wake of the primary syndrome not being recognized: low self-esteem, depression, boredom and frustration with school, fear of learning new things, impaired peer relations, sometimes drug or alcohol abuse, stealing, or even violent behavior due to mounting frustration. The longer the diagnosis of ADD is delayed, the greater the secondary problems may become. There are a great many adults out there in the world with undiagnosed ADD who think of themselves in all sorts of unnecessary negative terms. They may have fast-track hyperkinetic personalities, be impatient, restless, impulsive, often intuitive and creative but unable to follow through, frequently unable to linger long enough to develop a stable intimate relationship. Usually, they have self-esteem problems that began in childhood. The earlier the diagnosis can be made, the better these secondary problems can be managed, the sooner one can begin the creative process of learning to live with one’s brain without the obstacles of moralistic or taunting labels.

  Max’s story is also meant to illustrate how ADD occurs within a developmental framework. That is to say, it evolves over time, just as a child’s personality and cognitive ability evolve over time. It is not a stagnant phenomenon but a dynamic one, and its influence changes over time. The tasks of each stage of development may be unnecessarily difficult as long as the ADD remains undiagnosed. Even with a proper diagnosis, ADD will pose problems along the way, but at least the problems will be recognized.

  Although we tend to focus on the cognitive aspects of ADD, it is equally important to pay attention to how this disorder affects relations between people. Max’s friends thought he was egocentric or on drugs, that these possibilities explained his spacing out or failing to connect with them; many adults also misinterpret the emotional style of the ADD child. People with ADD often do not pick up on the subtle social cues and messages that are crucial in getting along with others. They may appear to be blasé or indifferent or self-centered or even hostile when they are simply confused or unaware of what is going on around them. As they becom
e more confused, they may get angry or they may withdraw, both responses causing interpersonal damage. Bear in mind that just as the child may have trouble focusing on his math assignment, so he may also have a hard time listening to an account of what his friend did over the summer. These problems with people can be just as damaging over the long run to one’s ability to get on in the world as the cognitive problems.

  The family problems alluded to in Max’s story can be severe indeed and contribute heavily to the painful experience of ADD. Children with ADD are often the source of family squabbles or marital discord. Parents get so angry and frustrated that they lash out, not only at the child but at each other. Soon full-scale battles erupt as the child becomes the scapegoat for everything that’s wrong in the family. This same process can happen in the classroom. Two or three children with undiagnosed ADD can turn a happy classroom into a war zone and a kind and competent teacher into a burned-out wreck. ADD is almost never a one-person problem. It affects whole classrooms and entire families.

  The next example centers on a family.

  Theresa and Matt were married without children when Theresa met David and Danny, a set of twins. She was working as a pediatric nurse in a hospital in Providence. “David and Danny were three years old,” Theresa explained. “They were patients of the pediatrics ward. That was the first contact I had ever had with them. They were admitted to the hospital for social reasons. They had severe failure to thrive but really were admitted for social reasons.

  “It was very apparent in the emergency room that their mother was mentally unable to take care of the children. They were in the hospital for three and a half months. I would see them every day because they were sick children, but they were also running wild throughout the ward every day. I would go down there and they would be just starving for attention, and they loved anybody who gave them attention. I would go down there every day and they would be sort of all over me, running around, throwing things, climbing on me. That’s how I got to know them.”

  The prevalence of ADD is higher among foster children and adopted children than it is among the general population. It has been suggested that this is due to higher rates of parental risk factors associated with ADD, such as drug abuse and mental illness, among the people who give their children up for adoption or have children removed from the home. In any case, the state placed Danny and David with Theresa and Matt. After various negotiations with the Department of Social Services (DSS), Theresa and Matt were allowed to adopt the twins. But there were many problems along the way. Danny and David were wild, out-of-control kids. They were in constant motion, eating erratically, unable to carry on what would be considered normal conversations for their age. It was clear to Theresa from the moment she met them that there was something wrong. The only question was what. Certainly, one part of the problem was that for the first three years of their lives they had not had a stable home or adequate shelter or sufficient nourishment. How much neurological damage was done during those years remains unclear.

  But even after they had been nourished properly and stabilized in the home of Theresa and Matt, severe difficulties persisted. Theresa said, “There were behavior problems. At day care they were on the verge of being dismissed because the daycare center could not handle them—their activity level, their impulsiveness, the fact that they couldn’t lay down and sleep when everybody else did, that they would want something and then get it without asking. If they wanted something, they just went after it. If they wanted to do something, then they did it. If they were outside and felt like climbing up six feet on a pole and jumping off, at the age of four, they would do it! They had no control over their behavior at all. So when we took them to the psychiatrist, the recommendation was that they go to a special school that could handle their ‘emotional problems.’ ”

  For the next couple of years the boys were treated in a special therapeutic nursery school. It was thought by the school that their disruptive behavior was due to unconscious, repressed feelings they harbored about being adopted, about being “abandoned” by their biological mother. Theresa vigorously disagreed with this assessment but went along with the treatment because she had been told by the Department of Social Services to do so. Since at that time she did not have legal custody of the children, she was compelled to do what the DSS told her or face losing the children.

  The situation did not improve as treatment at the special school went on. As Theresa put it, “Both Danny and David had several teachers in the groups [in the therapeutic day school]. I had to hire them a tutor because I realized that they were not learning anything. Now they were seven, going on eight, and they still didn’t know how to read numbers, they didn’t know anything. I thought they were learning things at the school, but I came to find out they weren’t learning reading and writing and arithmetic. They spent fifteen minutes a day on these things and the rest of the day was spent on therapy. Therapy was getting together and sitting in a group with the other little children and discussing what your problems were. And if you didn’t discuss your problems, you were timed out. If you wouldn’t talk, you were timed out. Timed out meant that you went and you sat on somebody’s lap in the group; time out from group was that. If you fought them, to get off their lap, you were then held to the ground by two of them until you ‘gained control of yourself.’

  “Well, Danny and David did not gain control of themselves. They just fought all the more. They would come home and tell me that so and so had a bloody nose today because they were held on the floor and the person banged their face against the floor when they were holding them down. Frequently, Danny and David were held to the floor by two people, one on the arms, one on the legs. Danny and David were able, by the end of the year, to display to me—me, who had worked in pediatrics for years—how to control a child who was out of control, better than I could ever, ever have done myself. They knew exactly. There is no doubt in my mind that this kind of physical restraint was done to them frequently because they knew exactly how to restrain a child so that he could not move.”

  I asked whether the school restrained them this way because they wouldn’t talk about their problems.

  “It was because they wouldn’t talk or wouldn’t participate in some group. Or Danny and David would start doing cartwheels during group therapy, or they would be looking out the window or get up and walk around in circles. Danny was always the one who was more active and he would be the one who would be more disruptive, not in the manner that he would talk out, but in the manner that he would be going off on his own or doing something or standing on his head. He went through several years of standing on his head continually.

  “So that’s how the school would handle the problem. They continually badgered Danny and David about their biological mother, about why Danny and David wouldn’t talk about her, about how it was OK to talk about her, about how it was OK to talk about the fact that she left them. Her leaving them was continually put into their heads. What Matt and I had been telling Danny and David all along was the truth of the matter: their biological mother was mentally unfit. But that’s not the way we would put it. We would tell them that their biological mother was unable to take care of them because she had problems. She loved them, she wanted them, she fought for them, but she just could not manage having children with her. And the school would continually contradict that message with their message about a mother who had abandoned her children. I would fight with the school and tell the school that it was wrong for them to tell the kids bad things, untrue things, about their mother. I told the school the kids were not to be told that their biological mother left them. She did not leave them. They were taken away from her. Instead, the school insisted on telling Danny and David that she left them and they should talk about it, talk about it, talk about it. If they didn’t, they would be, you know, reprimanded.”

  The school felt that the boys needed more intensive treatment. Theresa said, “Their recommendation, based on all their psychological testing, was t
o put Danny into a Point Four program in the local public school system. A Point Four program is the most restrictive program that you can have in a public school system. And they recommended that David go to a Point Five program, which is a step before a residential program, a step before placing him as an inpatient at a psychiatric hospital. There was still no diagnosis except for the diagnosis of emotional problems. Basically, we were told by the school that Danny and David would never really be anything. They had low IQs, according to the school, and with their history, they said, would never amount to anything.”

  The parents did not believe this assessment. After extensive haggling with the DSS, they got permission to take Danny and David out of the special school and place them in the local public school. This school happened to have an excellent learning specialist who suggested that the diagnosis of ADD might be worth looking into. This points up the importance of a second opinion. For years the special school, staffed by top-notch professionals, had believed in one working diagnosis, namely behavioral problems due to emotional conflict. And, indeed, that diagnosis was accurate as far as it went. As is so often the case, once one diagnosis is made, it is terribly difficult for those who made it to revise that diagnosis. In this case a second opinion was needed from someone outside the school, someone not limited by adherence to a single precept.

  When Theresa and Matt got the opinion of the learning specialist at the new school, they found out that Danny and David had severe ADD as well. The treatment they had received at the special school, not aimed at ADD but rather at uncovering unconscious conflict, might have caused the children great harm had it not been stopped.